Journal of Anesthesia

, Volume 25, Issue 4, pp 509–515 | Cite as

Validation of the Japanese version of the quality of recovery score QoR-40

  • Yuu Tanaka
  • Takafumi Wakita
  • Shunichi Fukuhara
  • Makoto Nishiwada
  • Satoki Inoue
  • Masahiko Kawaguchi
  • Hitoshi Furuya
Original Article



The quality of recovery score QoR-40 is a recovery-specific and patient-rated questionnaire to assess the early postoperative health status of patients. However, the Japanese version of the QoR40 has not been established. The aim of this study was to validate the quality of recovery 40 Japanese version (the QoR-40J) according to the methods adopted by the International Quality of Life Assessment (IQOLA) project.


After obtaining ethics committee approval and consent, 192 general and otological surgical patients were studied. The QoR-40J was used to measure postoperative health status on day 3 and 1 month after surgery. The level of quality of life was also evaluated using a general, health-related quality of life questionnaire (Short-Form Health Survey-36 sub-scales; SF-36), at 1 month after the surgery. Psychometric analysis including the following properties: test–retest reliability, internal consistency, predictive validity, and measurement of responsiveness, was performed to validate the QoR-40J.


Test–retest reliability (Spearman’s correlation coefficient) and internal consistency (Cronbach’s α) of the QoR-40J were 0.887 and 0.91, respectively. A significant relationship was observed between the total QoR-40J score and duration of hospitalization (r = −0.291) and between the global QoR-40J score and postoperative scores of the SF-36 sub-scales (physical function, ρ = 0.287; vital score, ρ = 0.349). The standardized mean of the QoR-40J, a measurement of responsiveness, was 0.70.


The results of the psychometric analysis indicated that the QoR-40J has characteristics of acceptable validity, reliability, and responsiveness in clinical practice in Japan. The QoR-40J may aid in evaluating the quality of recovery after surgery or the quality of methods of anesthesia.


Japanese QoR-40 Translation Quality of life Cross-cultural 



We thank Professor Paul Myles for granting us permission to translate the QoR40 into Japanese.


  1. 1.
    Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth. 2000;84:11–5.PubMedGoogle Scholar
  2. 2.
    Troedel S, Leslie K, Irwin K, Pearce F, Ugoni A, Gillies R, Pemberton E, Dharmages S. Quality of recovery from anaesthesia in neurosurgical patients. Anesthesiology. 2003;99:1158–65.PubMedCrossRefGoogle Scholar
  3. 3.
    Myles PS, Hunt JO, Fletcher H, Solly R, Woodward D, Kelly S. Relation between quality of recovery in hospital and quality of life at 3 months after cardiac surgery. Anesthesiology. 2001;95:862–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Bost JE, Williams BA, Bottegal MT, Dang Q, Rubio DM. The 8-item short-form health survey and the physical comfort composite score of the quality of recovery 40-item scale provide the most responsive assessments of pain, physical function, and mental function during the first 4 days after ambulatory knee surgery with regional anaesthesia. Anesth Analg. 2007;105:1693–700.PubMedCrossRefGoogle Scholar
  5. 5.
    Bullinger M, Alonso J, Apolone G, Leplège A, Sullivan M, Wood-Dauphinee S, Gandek B, Wagner A, Aaronson N, Bech P, Fukuhara S, Kaasa S, Ware JE Jr. Translating health status questionnaires and evaluating their quality: the IQOLA project approach. J Clin Epidemiol. 1998;51:913–23.PubMedCrossRefGoogle Scholar
  6. 6.
    Fukuhara S, Bito S, Green J, Hisao A, Kurokawa K. Translation, adaptation and validation of the SF-36 Health Survey for use in Japan. J Clin Epidemiol. 1998;51:1037–44.PubMedCrossRefGoogle Scholar
  7. 7.
    Spector PE. Summated rating scale construction: an introduction. Sage University Paper series on quantitative application in social science, No. 82. London: SAGE Publication Inc.; 1992.Google Scholar
  8. 8.
    Myles PS, Hunt JO, Nightingale CE, Fletcher H, Beh T, Tanil D, Nagy A, Rubinstein A, Ponsford JL. Development and psychometric testing of a quality of recovery score after general anaesthesia and surgery in adults. Anesth Analg. 1999;88:83–90.PubMedGoogle Scholar
  9. 9.
    Katz JN, Larson MG, Phillips CB, Fossel AH, Liang MH. Comparative measurement sensitivity of short and longer health status instruments. Med Care. 1992;30:917–25.PubMedCrossRefGoogle Scholar
  10. 10.
    McDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. 2nd ed. New York: Oxford University Press; 1996.Google Scholar

Copyright information

© Japanese Society of Anesthesiologists 2011

Authors and Affiliations

  • Yuu Tanaka
    • 1
  • Takafumi Wakita
    • 2
  • Shunichi Fukuhara
    • 3
  • Makoto Nishiwada
    • 4
  • Satoki Inoue
    • 1
  • Masahiko Kawaguchi
    • 1
  • Hitoshi Furuya
    • 1
  1. 1.Department of AnesthesiologyNara Medical UniversityKashiharaJapan
  2. 2.Department of Psychology, Faculty of SociologyKansai UniversitySuitaJapan
  3. 3.Department of Epidemiology and Health Care ResearchKyoto UniversityKyotoJapan
  4. 4.Department of AnesthesiologyTenri General HospitalTenriJapan

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